Study of prevalence of rheumatic heart disease among school children in central Nepal  

Objective: To determine the prevalence of rheumatic heart disease (RHD) and the pattern of valvular involvement  among school children in Chitwan and Nawalparasi districts.
Methodology: This is a cross-sectional study involving 28050 school children from general schools and private boarding schools. The school children were clinically examined in the school by a team of cardiologists and those having cardiac murmurs were assessed at the site with transthoracic two dimensional echocardiography along with colour doppler. Age-specific rates (prevalence/thousand) of murmurs and RHD were calculated.
Results: The age of the students ranged from 4 to 15 years with mean age of  9±2 years with girls preponderance (Girl: Boy =1.15:1) (p=0.25). Cardiac murmurs were appreciated in 1130 students (40.28/1000 students) with similar prevalence in boys (39.60) and girls (41.28) (p=0.5). Definite RHD was detected in 29 students (1.03/1000students). The dominant rheumatic cardiac lesions were isolated mitral regurgitation (MR-13) followed by mixed mitral stenosis (MS) and MR in 5 students, isolated mitral stenosis in 2 students, aortic regurgitation in 2students and mixed MR and AR in 2 students(p<0.05 among mitral valve vs other valves involvement). 8 students(27.58%) had severe valvular lesions. 3 of the children had already undergone mitral valve replacement.5 of them had developed heart failure as per Framingham criteria. Acute rheumatic fever was diagnosed in only 3 patients(10.34%).21(72.41%) of the rheumatic students were on treatment with penicillin therapy(p<0.05).
Conclusions: RHD is still one of the most common cardiac disease among school children in central Nepal. There is severe valvular involvement even in very young age. So, the RHD screening programme should be more effectively and widely conducted to diagnose and treat it early.